Disaster & Emergency Medicine Project

Australian Doctor Magazine

Articles Published 14th February, 1997 pp 32-33 (Reproduced by permission)

In the line of fire

A new disaster strategy for GPs

When bushfires hit Victoria recently local GPs were prepared. The fires raged on the doorstep of Dr George Somers, who has developed a disaster management plan with GPs as the linchpin. Now his plan has proved itself locally, he says all GPs could use it.

CATHY SAUNDERS reports.

A crisis is looming in the field of disaster medicine, says Emerald GP Dr George Somers.

Disasters are becoming more common in Australia but the means with which to respond are decreasing. Most GPs expect one day to have to respond to a disaster and the statistics justify their expectations, Dr Somers says.

In Victoria alone the state emergency response plan (Displan) responds to more than 50 major call-outs per year. Fewer ambulance services, the scaling down of army medical resources, erosion of reserve capacities of hospitals and a general deskilling of GPs have led the the impending crisis.

"Community expectations have risen to expect intensive care for all, at all times, in all places". But the crisis won't happen if he can help it. Dr Somers has a plan.

GPs are the linchpin of his disaster management plan, which involved GPs so effectively during the recent bushfires. He believes it is the first to use organised GP teams as the field medical teams sent to a disaster site. Dr Somers says the current response to a disaster is to fly a field medical team in from a large distant hospital. However, there are usually GPs near any disaster site, they are generally available 24 hours a day and so can mobilise rapidly, they are aware of local resources, and they know how to overcome local obstacles.

"The golden hour 1-2 hours after ... [major trauma] is that in which the greatest improvement in outcome can be made," says Dr Somers, who presetented his disaster and emergency model at the RACGP's annual conference in Perth last year. GPs' early involvement is also useful because they are likely to manage the local victims' physical and psychological needs for months afterwards. They are the cornerstone of local community recovery, he says.

Trial by fire

Victoria's recent bushfires, which claimed three lives, raged only kilometres from Dr Somers' practice. He says the disaster and emergency strategy worked well and GPs and nurses were mobilised rapidly. The GPs involved were pleased to have a co-ordinated plan of action, unlike the Ash Wednesday bushfires when many felt aimless because they were not given directions.

On the afternoon of the fires the state's Displan chief medical co-ordinator Dr Andrew Bacon rang the area medical co-ordinator, who contacted Dr Somers, the key GP contact for the area, asking him to arrange a team to be on stand-by. Dr Somers and his second-in-command, another local GP, swung the new plan into action, using the Emerald Medical Centre as the GP headquarters.

"We rang around and within half an hour or so we had 10 GPs on stand-by and we called six nurses in to the Emerald Medical Centre," Dr Somers says. In the meantime, two local hostels for geriatric patients were evacuated, on Dr Somers' orders, and the 34 patients taken to the medical centre.

...

He says the nurses were a god-send, stabilising and tending to the patients. The Red Cross brought food for the patients and a bus was provided to move them to hospitals closer to Melbourne. In the middle of the action Dr Bacon, a Melbourne anaesthetist, rang asking for a doctor at four evacuations sites. "We were able to ring him back in less than an hour and say we had a doctor and nurse at each of the four sites," Dr Somers says. "That was an unexpected new role that we played."

To spread the word about the local plan, a debriefing and education session was held involving GPs, nurses, police, CFA and regional representatives. The model has been met with enthusiasm by various groups, including the Victorian Displan.

Dr Bacon says it is GPs who are likely to be on-hand for many major disasters. "Away from the main cities and the immediate area of large teaching hospitals and base hospitals, it really is the GP who may be confronted with some of the worst disasters we are likely to face," he says. He says the model complements, rather than competes with, Displan because it provides a local resource of people informed about the role of the official state counter-disaster plans, and teaches them disaster management as distinct from emergency medicine.

Following the plan's success, Dr Somers hopes it will be implemented across the country. "We have proven it works locally and now it is time to spread it throughout Victoria," he says. Because each state has a different disaster plan, he also plans to adapt his model to suit each one.

"I also hope eventually to go international because some Asian countries are interested in a disaster plan using local doctors," Dr Somers says.

Webmaster's note : {URL to The plan model document in detail}

GPs need to increase confidence

While most GPs expect to have to deal with a disaster and are willing to help, they often don't have the confidence or skills to cope, Dr Somers' research shows. He has conducted surveys which found that :

• 90% of GPs are willing to attend a local disaster.
• Although 82% feel they are likely one day to have to respond to a disaster, only 35% feel confident about their skills and 71% say they should have more knowledge in th area.
• Although 88% have basic skills of early managment of surgical trauma, only 35% have advanced skills. The three skills that determine an advance level are orotracheal intubation, needle cricothyrotomy and needle thoracocentesis.
• 90% say an upskilling course would make them feel more confident in a disaster and 55% say they would only feel comfortable attending a disaster if they had completed such a course.

Dr Bacon says GPs faced with an emergency tend to revert to their basic training, which may have been 30 years ago, so it is important to implant new patterns of managing emergencies and surgical trauma.

Dr Somers, who defines disaster medicine and emergency medicine in a disaster setting and one which requires special skills agrees. He says GPs will need upskilling to be confident and competent to attend disasters. In conjucntion with the Victorian Centre for Rural Health, he is devising an upskilling package. He envisages a "travelling circus" - a trainer with a van full of equipment - which would tour rural divisions to teach GPs the hands-on elements of the package. There would probably be a seminar format in urban areas.

Dr Somers is adamant that GPs learing emergency medicine should be taught extrea skills to help them cope in a disaster. He is pushing for this with the RACGP and the Australian College of Rural and Remote Medicine, which are currently devising policies on emergency medicine. Dr Somers says rural trainees could take upskilling packages as part of their course. GPs completing the modules could be awarded a certificate in disaster medicine, which would help field medical team leaders identify the strengths of the team. Dr Somers sees a spin-off for road-side accidents, which he says GPs are notoriously loath to attend. "Once GPs learn the basic skills [of disaster medicine], one way to keep them is attending roadside accidents."

He says they can also use the skills in the surgery.

He has applied for a Federal projects grant of $670,000 to establish the project in rural Victoria over two years.

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